My goal in seeking a K23 Mentored Patient-Oriented Research Career Development Award is to acquire the knowledge and skills to become an independent clinical investigator and a leader in cardiopulmonary imaging research. I have a broad background in ultrasonography, with specific expertise in lung ultrasonography and point-of-care echocardiography which are key research areas for this application. I propose to investigate the relationship of pulmonary congestion assessed by lung ultrasound (LUS) and acute decompensated heart failure (ADHF). Pulmonary congestion, often manifested by breathlessness (dyspnea), is the most common sign of ADHF and the leading cause of hospitalization in the U.S. population over 65 years of age. Patient reported dyspnea is used both clinically and in trials as a surrogate marker of pulmonary congestion, because the detection and quantification of pulmonary congestion based on current methods remains challenging. Although patient symptoms represent an important treatment goal, there is a critical need for novel quantitative markers of pulmonary congestion. Lung ultrasound (LUS) is a novel, semi-quantitative tool in the assessment of pulmonary congestion that has been identified as a useful point-of-care tool in the evaluation of undifferentiated dyspnea. B-lines are vertical lins on LUS which, when quantified, provide a graded measure of extra-vascular lung water. Although LUS has been used clinically as a diagnostic tool in the acute care setting, little is known about the correlates, dynamic changes and prognostic value of this method. In aim 1, we will examine the cross-sectional association of baseline B-line number with conventional clinical, biomarker, and imaging correlates of congestion, as well as short term outcomes. In aim 2, we will determine the extent to which B-line number decreases in response to therapy. In aim 3, we will examine the association of pre- discharge B-line number with long term outcomes, including heart failure related readmissions and death. These aims will be investigated at two leading academic institutions with an extensive track record of heart failure and imaging research, as well as mentorship of early career investigators. The long term goal of this proposal is to improve the assessment of pulmonary congestion in patients with heart failure and to determine the extent to which LUS as a novel imaging tool can measure sub-clinical pulmonary congestion, guide titration of therapy, and predict adverse outcomes in this population. The proposed research will be conducted in the context of a comprehensive five-year career development training program with the goal of providing me with the knowledge and skills to become an independent clinical investigator in cardiopulmonary imaging research at the interface of emergency medicine and cardiology. A team of accomplished mentors and collaborators with expertise in cardiac imaging, heart failure, quality of life assessment, epidemiology, biostatistics, and clinical trials will guide me in my transition to scientific independence.